Abstract
ABSTRACTOBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection.METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil.RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted.CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.
Highlights
The Brazilian National Health System (SUS) surveillance system is responsible for investigating causes of death related to infectious diseases in the state of São Paulo[1]
The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology
Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent
Summary
The Brazilian National Health System (SUS) surveillance system is responsible for investigating causes of death related to infectious diseases in the state of São Paulo[1]. When a diagnosis of the cause of death is uncertain, the system performs a post-mortem analysis encompassing all available clinical, laboratory and epidemiological evidence to assess possible etiological agents. This represents the final opportunity to establish the most likely diagnosis and subsequently alert public health officials to initiate improved surveillance measures. Arboviruses (ARthropod-BOrne virus) are responsible for a large number of different infections with similar clinical manifestations, ranging from mild to severe febrile illnesses, hemorrhagic fever, and neuroinvasive diseases[2]. When caused by non-Arbovirus diseases, laboratory analysis play a pivotal role in the differential diagnosis of hemorrhagic fever (leptospirosis, spotted fever, hantavirus5) and neuroinvasive diseases (such as meningitis, herpes, rabies[6])
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